Spinal intradural cystic venous angioma originating from a nerve root in the cauda equina

Abstract

V ascular lesions comprise approximately 6%-7% of all spinal intradural tumors. 12 Spinal vascular malformations may be classified as capillary telangiectasias, cavernous angiomas, arteriovenous malformations, or venous angiomas. 9 Venous angiomas are the most frequently encountered cerebral vascular malformations, with an incidence of up to 2.6% in a series of 4069 brain autopsies.14 However, spinal venous angiomas are extremely rare lesions. Only 2 previous reports of spinal epidural venous angiomas 3,9 have been found, but a previous report on spinal intradural venous angiomas was not encountered.We present an extremely rare spinal, intradural, extramedullary cystic venous angioma originating from a spinal nerve root in the cauda equina, which appears to be the first recorded example with a detailed assessment using MRI, intraoperative photography, and immunohistochemistry. Case ReportHistory and Examination. A 54-year-old woman had a 4-year-history of low-back pain. This was followed by the development of left-sided pain in the hip, thigh, and inguinal and perianal regions, with progressive worsening during the 2 weeks prior to admission. On examination, the patient had severe left-sided pain and numbness in the hip, thigh, and inguinal and perianal regions, but no muscular weakness. She also had normal rectal tone and bladder function. Laboratory analysis revealed no abnormalities.A lumbar spine MR image revealed a cystic mass at Division of Neurosurgery, St. Michael's Hospital, University of Toronto, Ontario, CanadaA spinal intradural extramedullary venous angioma is extremely rare and has not been previously reported. In this paper, the authors report on this entity with morphological and immunohistochemical evidence, and discuss the surgical strategy for its treatment. A 54-year-old woman presented to Nagoya University Hospital complaining of left-sided pain in the hip, thigh, and inguinal and perianal regions, with progressive worsening during the previous 2 weeks. Lumbar spine MRI showed an intradural extramedullary cyst at the level of T12-L1, which extended from the conus medullaris to the cauda equina. The cyst wall was not enhanced on T1-weighted MRI with Gd. Intraoperatively, a midline dural opening allowed the authors to easily visualize a dark-reddish cyst behind the spinal nerve rootlets in the cauda equina adjacent to the conus medullaris. The cyst was believed to originate from one of the spinal nerve rootlets in the cauda equina and a cluster of veins was identified on the cyst wall. The cyst was resected with the affected nerve rootlet. The surgery left no detectable neurological deficit. Based on the morphological and immunohistochemical evidence, the lesion was diagnosed as a venous angioma. No tumor recurrence was confirmed based on MRI at the time of the 2-year follow up. This is the first report of an intradural extramedullary cystic venous angioma that was successfully resected. (http://thejns.org/doi/abs/10.3171/2013.8.SPINE121012) keY WorDs • venous angioma • intradural • cysti...

Spinal epidural venous angioma presenting symtomps of lumbar disc herniation: a case report

“…Venous malformations, described as varicose veins or racemose varicose veins, are composed entirely of veins, either Histologically, venous angiomas show significant hyaline and collagenous thickening in the vessel wall. Thrombosis and inflammation of the various veins can be seen with immunohistochemical analysis revealing surface-lining epithelial cells positive for CD31 (12). Racemose venous angiomas are located in the extradural space.…”

A case of spinal epidural venous malformation with mediastinal extension: management with combined surgery and percutaneous sclerotherapy

“…The MRI features of intraspinal venous malformations are variable, as shown in reported cases. 6,13,15,20,22 Lesions with hemorrhage, liquefaction of hematomas, or intravascular thrombosis can have different signal on MRI or heterogeneous enhancement. 12,33 A precise preoperative diagnosis based on imaging features is often difficult.…”

“…Since a venous malformation is histologically benign and usually well marginated, gross-total removal should be attempted during surgical exploration. 21,22,24,27,31 For patients with lesions growing around vital structures (such as the vascular tree, spinal cord, or within the pleural cavity), total resection may come at the risk of serious complications. 3 We resected the dorsal component of the venous malformation but did not attempt to resect the ventral component because retracting the spinal cord in this location carries a high risk of paralysis.…”